Sant'Andrea Hospital, Hematology Unit, Faculty of Medicine and Psychology, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy,
Ann Hematol. 2014 Aug;93(8):1413-20. doi: 10.1007/s00277-014-2053-9. Epub 2014 Mar 20.
Myelodysplastic syndromes (MDS) are common in elderly patients. Recombinant human erythro-poietin (rHuEPO) has been widely used to treat anemia in lower risk MDS patients, but few data are known about rHuEPO treatment in the very elderly patient group. In order to investigate the role of rHuEPO treatment in terms of response, overall survival (OS), and toxicity in a very elderly MDS patient group, 93 MDS patients treated with rHuEPO when aged ≥80 years were selected among MDS cases enrolled in a retrospective multicenter study by the cooperative group Gruppo Romano Mielodisplasie (GROM) from Jan 2002 to Dec 2010. At baseline, median age was 82.7 (range 80-99.1) with a median hemoglobin (Hb) level of 9 g/dl (range 6-10.8). The initial dose of rHuEPO was standard (epoetin alpha 40,000 IU/week or epoetin beta 30,000 IU/week) in 59 (63.4 %) patients or high in 34 (36.6 %) (epoetin alpha 80,000 IU/week) patients. We observed an erythroid response (ER) in 59 (63.4 %) patients. No thrombotic event was reported. Independent predictive factors for ER were low transfusion requirement before treatment (p = 0.004), ferritin <200 ng/ml (p = 0.017), Hb >8 g/dl (p = 0.034), and a high-dose rHuEPO treatment (p = 0.032). Median OS from rHuEPO start was 49.3 months (95 % CI 27.5-68.4) in responders versus 30.6 months (95 % CI 7.3-53.8) in resistant patients (p = 0.185). In conclusion, rHuEPO treatment is safe and effective also in the very elderly MDS patients. However, further larger studies are warranted to evaluate if EPO treatment could be worthwhile in terms of quality of life and cost-efficacy in very old patients.
骨髓增生异常综合征（MDS）在老年患者中较为常见。重组人红细胞生成素（rHuEPO）已广泛用于治疗低危 MDS 患者的贫血，但关于高龄 MDS 患者群体中 rHuEPO 治疗的数据较少。为了研究 rHuEPO 治疗在反应、总生存（OS）和毒性方面对高龄 MDS 患者群体的作用，选择了 2002 年 1 月至 2010 年 12 月期间，协作组 GruppoRomanoMielodisplasie（GROM）通过回顾性多中心研究招募的 MDS 病例中年龄≥80 岁的 93 例 MDS 患者接受 rHuEPO 治疗。在基线时，中位年龄为 82.7 岁（范围 80-99.1），中位血红蛋白（Hb）水平为 9 g/dl（范围 6-10.8）。59 例（63.4%）患者初始 rHuEPO 剂量标准（促红细胞生成素α40000IU/周或促红细胞生成素β30000IU/周），34 例（36.6%）患者高剂量（促红细胞生成素α80000IU/周）。我们观察到 59 例（63.4%）患者出现红细胞反应（ER）。未报告血栓事件。ER 的独立预测因素为治疗前低输血需求（p=0.004）、铁蛋白<200ng/ml（p=0.017）、Hb>8g/dl（p=0.034）和高剂量 rHuEPO 治疗（p=0.032）。反应者 rHuEPO 起始后中位 OS 为 49.3 个月（95%CI 27.5-68.4），无反应者为 30.6 个月（95%CI 7.3-53.8）（p=0.185）。总之，rHuEPO 治疗在高龄 MDS 患者中也是安全有效的。然而，需要进一步进行更大规模的研究，以评估在高龄患者中，EPO 治疗在生活质量和成本效益方面是否值得。
